Primary Umbilical Endometriosis: A case report and management with review of literature

Introduction-we report a case of primary umbilical endometriosis(UE) in the absence of any pelvic  endometriosis with the aim to discuss the management of this rare entity.

Case presentation-  A 35 years old female P1L1 who conceived after ovulation induction and delivered vaginally. She presented with complaints of  cyclical bleeding from umbilicus and pain in the umbilical region during menstruation. Ultrasound and MRI showed a we’ll defined lesion of 1.5x2 cm in the subcutaneous plane deep in umbilical region communicating with skin. Excision of umbilicus with deep seated endometriotic tissue followed laparotomy  and umbilical reconstruction was performed. Histopathology examination confirmed the diagnosis of umbilical endometriosis. Neither signs nor symptoms have recurred after 6 months of follow up.

Discussion- UE can occur in the absence any previous surgical scar or  typical signs symptoms of pelvic endometriosis in the women of reproductive age. In such scenario clinical diagnosis may be difficult and other differential diagnosis needs to be excluded specifically malignant cause, CEMRI abdomen and FNAC of lesion can be of great importance. Though the main stay of treatment is wide excision of the lesion with or without removal of the umbilicus followed by laparotomy/laparoscopic exploration of peritoneal cavity. Surgical radicalisation depends on size, extend, duration of symptoms and possibility of  pelvic or peritoneal endometriosis.